Adverse events from systemic therapies for psoriasis are common in clinical practice

Abstract

Traditional psoriasis therapies are associated with significant adverse events in some patients despite toxicity-sparing approaches such as combination therapy. Clinicians need to be aware of screening for adverse events in order to best ensure the safety of their patients and to maximize the efficacy of a given agent. There is still a need for the development of safe and effective treatments for patients with moderate-to-severe psoriasis.

Adverse events resulting in withdrawal of biologic therapy for psoriasis in real-world clinical practice: A Canadian multicenter retrospective study

“…In 1 study by Pearce et al, 14 the frequency of AEs associated with various systemic psoriasis therapies including biologics was reported. However, the small sample size for patients on biologic therapy (n = 29) and the absence of further classification into the specific biologic agents limit the generalizability of the findings.…”

Multiple toxic effects of low-dose methotrexate in a patient treated for psoriasis

“…Cutaneous manifestations ranging from a mild, macular, punctate rash to severe life-threatening SJS are relatively common adverse events secondary to low-dose methotrexate therapy. 4,11 A less common manifestation of methotrexate toxicity is painful erosion of psoriatic plaques. This occurrence is rare; however, since 1967, there have been at least 17 reported cases of patients who were diagnosed with erosion of psoriatic plaques secondary to methotrexate toxicity.…”

“…4 In a recent retrospective review of methotrexate use in clinical practice, 50% of patients reported an adverse event while on therapy, with 32% of those being classified as "significant." 11 Day et al 12 proposed a classification system for ADRs secondary to low-dose methotrexate, dividing the ADRs into four distinct categories based on relation to dosing: type A-dose dependent, type B-idiosyncratic, type C-cumulative dose, and type D-delayed events after drug discontinuation. Our patient had multiple toxicities of pancytopenia, oral ulcerations, and cutaneous lesions in the setting of multiple risk factors including drug-drug interactions, acute renal failure, relative folate deficiency, and medication dosing errors.…”

Efficacy of Systemic Treatments for Moderate to Severe Plaque Psoriasis: Systematic Review and Meta-Analysis

“…Second, many adverse events occur over periods beyond the time horizons of most RCTs. Preliminary evidence from clinical practice suggests that toxicities are a more significant issue for conventional systemic therapies than for biologic agents [39]. …”